Treatment Outcomes of Germ Cell Tumors of Ovary: Single Institutional Study

Rohit Kumar Jha (Department of surgical oncology, Rajendra Institute of Medical Sciences, Ranchi)
Ajit Kumar Kushwaha (Department of surgical oncology, Rajendra Institute of Medical Sciences, Ranchi)
Mukunda Kumar (Department of Biochemistry, All India Institute of Medical Sciences, Patna)
Sunaina Wadhwa (Ex-fellow, Department of Gynaecological Oncology, TMC, Kolkata)
Sumedha Gargy (Department of surgical oncology, Rajendra Institute of Medical Sciences, Ranchi)

Abstract


5% of all ovarian tumours are accounted to germ cell tumours (GCT’s).Affecting mostly young women, the highest incidence is seen in second and third decade of life. They are highly malignant but chemosensitive and more curable than their epithelial counterparts. Treating these tumors with effective surgery and combination chemotherapy survival rates have dramatically improved in recent decades. We present our experience of ovarian germ cell tumours in the department of Surgical Oncology, Rajendra Institute of Medical Sciences (RIMS), Ranchi with special emphasis on treatment outcomes. A retrospective review of hospital medical records of patients with ovarian germ cell tumours diagnosed and treated at RIMS from June 2019 to August 2020, was performed. Clinical profile and treatment outcome of patients were recorded. A total of 19 patients met criteria. The median age at diagnosis was 20 years (range 11-42 years) and all had good performance status. All except two patients underwent surgery, 70.6% and 29.4% in upfront and interval debulking surgery (IDS) setting respectively. Fertility preserving surgery was done in 75% patients in the primary surgery group and 60% undergoing IDS.83.3% patients received BEP as adjuvant chemotherapy whereas 80% as neo-adjuvant chemotherapy.

Majority (31.5%) patients had dysgerminoma as final histology, followed by mixed histology(26.3%), yolk sac tumour (15.7%),immature teratoma (15.7%) and choriocarcinoma (10.5%). 47.3% patients were in Stage I at the time of diagnosis. 78.9% patients were alive without disease, 10.5% recurred, and 10.5% were lost to follow up.


Keywords


Germ cell tumour;Dysgerminoma;BEP;Fertility sparing surgery;Yolk sac tumour

Full Text:

PDF

References


[1] Gershenson DM, Copeland LJ, Kavanagh JJ, Cangir A, Junco GD, Saul PB, et al. Treatment of malignant nondysgerminomatous germ cell tumors of the ovary with vincristine, dactinomycin, and cyclophosphamide. Cancer, 1985, 56: 2756-61.

[2] Slayton RE, Park RC, Silverberg SG, Shingleton H,Creasman WT, Blessing JA. Vincristine,dactinomycin, and cyclophosphamide in the treatment of malignant germ cell tumors of the ovary. A Gynecologic Oncology Group Study (a final report). Cancer, 1985,56: 243-8.

[3] Gershenson BDM. Menstrual and reproductive function after treatment with combination chemotherapy for malignant ovarian germ cell tumors. Am Soc Clin Oncol, 2016, 6: 270-5.

[4] Brewer BM, Gershenson DM, Herzog CE, et al. Outcome and reproductive function after chemotherapy for ovarian dysgerminoma. J Clin Oncol., 2017, 17:2670-5.

[5] Kanazawa K, Suzuki T, Sakumoto K.Treatment of malignant ovarian germ cell tumors with preservation of fertility: reproductive performance after persistent remission. Am J Clin Oncol., 2000,23: 244-8.

[6] Tangir J, Zelterman D, MaW, et al. Reproductive function after conservative surgery and chemotherapy for malignant germ cell tumors of the ovary. Obstet Gynecol., 2003, 101: 251-7.

[7] Murugaesu N, Schmid P, Dancey G, et al. Malignant ovarian germ cell tumors: Identification of novel prognostic markers and long term outcome after multimodality treatment. J Clin Oncol., 2006, 24:4862-4866.

[8] Downey J, McKinney M. The psychiatric status of women presenting for infertility evaluation. Am J Orthop, 1992, 62: 196-198.

[9] Zanetta G, Bonazzi C, Cantu M, Binidagger S,Locatelli A, BratinaG, Mangioni C. Survival and reproductive function after treatment of malignant germ cell ovarian tumors. J Clin Oncol., 2001,19(4):1015-1020.

[10] Zhang N, Chen R, Hua K, Zhang Y. A retrospective study of reproductive outcomes after fertility-sparing surgery and postoperative adjuvant chemotherapy in malignant ovarian germ cell tumors and sex cord-stromal tumors. Journal of Ovarian Research,2017, 10: 52.

[11] Turkmen O, Karalok A, Basaran D, Kimyon G. Fertility-Sparing Surgery Should Be the Standard Treatment in Patients with Malignant Ovarian Germ Cell Tumors. Journal of Adolescent and Adult Oncology,2017.DOI: 10.1089/jayao.2016.0086

[12] Maheshwari A, Gupta S, Parikh PM, Tongaonkar HB. Malignant germ cell tumor ovary-experience at Tata Memorial Hospital. Indian J Med Paediatr Oncol., 2004, 25(1): 43.

[13] Gershenson DM, Morris M, Cangir A, Kavanagh JJ, Stringer CA, Edwards CL, Silva EG,Wharton JT. Treatment of malignant germ cell tumors of the ovary with bleomycin, etoposide and cisplatin. J Clin Oncol., 1990, 8(4): 715-720.

[14] De Wit R, Roberts JT et al. Equivalence of three or four cycles of bleomycin, etoposide and cisplatin combination therapy and of a 3 or 5 day schedule in good prognosis germ cell cancer: a randomized study of the European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group and the Medical Research Council.J Clin Oncol., 2001, 19(6):1629-1640.

[15] Saxman SB, Finch D, Gonin R, Einhorn LH. Long term follow up of a phase III study of three versus four cycles of bleomycin, etoposide and cisplatin in favourable prognosis germ cell tumors: the Indian University experience. J Clin Oncol., 1998, 16(2):702-706.

[16] Talukdar S, Kumar S, Bhatla N , Mathur S, Thulkar S, Kumar L. Neo-adjuvant chemotherapy in the treatment of advanced malignant7germ cell tumors of ovary. Gynecologic Oncology, 2014, 132:28-32.

[17] Culine S, Lhomme C, Kattan J, Michel G, Duvillard P, Droz JP. Cisplatin based chemotherapy in the management of germ cell tumors of the ovary: the Institut Gustave Roussy Experience. Gynecol Oncol., 1997,64(1):160-165.

[18] Gershenson DM. Management of early ovarian cancer: germ cell and sex cord-stromal tumors.Gynecol Oncol., 1994, 55: S62-72.

[19] Weinstein D, Polishuk WZ. The role of wedge resection of the ovary as a cause for mechanical sterility.Surg Gynecol Obstet, 1975, 141: 417-8.

[20] Perrin LC, LowJ, Nicklin JLWardBG, Crandon AJ.Fertility and ovarian function after conservative surgery for germ cell tumors of the ovary. Aust N Z J Obstet Gynecol, 1999, 39(2):243-245.

[21] Ezzat A, Raja M, Bakri Y, Subhi J, Memon M,Schwartz P, Stuart R. Malignant ovarian germ cell tumors: a survival and prognostic analysis. Acta Oncol., 1999, 38(4): 455-460.

[22] Brewer M, Gerhenson DM, Herzog CE Mitchell MF,Silva EG, Wharton JT. Outcomes and reproductive function after chemotherapy for ovarian dysgerminoma. J Clin Oncol., 1999, 17(9):2670-2675.

[23] Park J, Kim D, Suh D, Kim J, Kim Y. Outcomes of pediatric and adolescent girls with malignant ovarian germ cell tumors; Gynecol Oncol, 2015.http://dx.doi.org/10.1016/j.ygyno.2015.03.054

[24] Weinberg L, Lurain J, Singh D, Schink J, Survival and reproductive outcomes in women treated for malignant ovarian germ cell tumors. Gynecologic Oncology, 2011, 121: 285-289.

[25] Tamauchi S, Kajiyama H, Yoshihara M, Ikeda Y,Yoshikawa N, Nishino K, Utsumi F, Niimi K, Suzuki S, Kikkawa F. Reproductive outcomes of 105 malignant ovarian germ cell tumor survivors: a multicenter study. Am J Obstet Gynecol., 2018, 219(4): 385.e1-385.e7.DOI: 0.1016/j.ajog.2018.07.021. Epub 2018 Aug 4.PMID: 30086295

[26] Patterson DM, Murugaesu N, Holden L, et al. A review of the close surveillance policy for stage I female germ cell tumors of the ovary and other sites.Int J Gynecol Cancer, 2008, 18: 43-50.24. Park J Y, Kim D Y, Suh D S,et al. Analysis of outcomes and prognostic factors after fertility-sparing surgery in malignant ovarian germ cell tumors. Gynecol Oncol., 2017, 145: 513-8.



DOI: https://doi.org/10.30564/jor.v3i1.2705

Refbacks

  • There are currently no refbacks.
Copyright © 2021 Sumedha Gargy, Rohit Kumar Jha, Ajit Kumar Kushwaha, Mukunda Kumar


Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.